Background:
Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States.
Purpose:
To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs.
Data Sources:
Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists.
Study Selection:
Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses.
Data Extraction:
2 investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention.
Data Synthesis:
Of 2661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from 3 studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of 6 studies found an increase in heroin overdoses after PDMP implementation.
Limitation:
Few studies, high ROB, and heterogeneous analytic methods and outcome measurement.
Conclusion:
Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of “best practices” and complementary initiatives to address these consequences.
Primary Funding Source:
National Institute on Drug Abuse and Bureau of Justice Assistance.
References
- 1.
Guy GP Jr ,Zhang K ,Bohm MK ,et al . Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66:697-704. [PMID:28683056 ] doi:10.15585/mmwr.mm6626a4 CrossrefMedlineGoogle Scholar - 2.
Han B ,Compton WM ,Jones CM ,Cai R . Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003-2013. JAMA. 2015;314:1468-78. [PMID:26461997 ] doi:10.1001/jama.2015.11859 CrossrefMedlineGoogle Scholar - 3.
McCabe SE ,West BT ,Veliz P ,McCabe VV ,Stoddard SA ,Boyd CJ . Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976-2015. Pediatrics. 2017;139. [PMID:28320868 ] doi:10.1542/peds.2016-2387 CrossrefMedlineGoogle Scholar - 4.
Patrick SW ,Schumacher RE ,Benneyworth BD ,Krans EE ,McAllister JM ,Davis MM . Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;307:1934-40. [PMID:22546608 ] doi:10.1001/jama.2012.3951 CrossrefMedlineGoogle Scholar - 5.
Rudd RA ,Aleshire N ,Zibbell JE ,Gladden RM . Increases in drug and opioid overdose deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;64:1378-82. [PMID:26720857 ] doi:10.15585/mmwr.mm6450a3 CrossrefMedlineGoogle Scholar - 6.
Hedegaard H ,Warner M ,Minino AM . Drug Overdose Deaths in the United States, 1999-2015. NCHS Data Brief no. 273. Hyattsville, MD: National Center for Health Statistics; 2017. Google Scholar - 7.
Hedegaard H ,Warner M ,Minino AM . Drug Overdose Deaths in the United States, 1999-2016. NCHS Data Brief no. 294. Hyattsville, MD: National Center for Health Statistics; 2017. Google Scholar - 8.
National Center for Injury Prevention and Control . From Epi to Policy: Prescription Drug Overdose. State Health Department Training and Technical Assistance Meeting. Atlanta: Centers for Disease Control and Prevention; 2013. Google Scholar - 9.
Office of National Drug Control Policy; U.S. Executive Office of the President . Epidemic: Responding to America's Prescription Drug Abuse Crisis. Washington, DC: Office of National Drug Control Policy; 2011. Google Scholar - 10.
Reisman RM ,Shenoy PJ ,Atherly AJ ,Flowers CR . Prescription opioid usage and abuse relationships: an evaluation of state prescription drug monitoring program efficacy. Subst Abuse. 2009;3:41-51. [PMID:24357929 ] CrossrefMedlineGoogle Scholar - 11.
Surratt HL ,O'Grady C ,Kurtz SP ,et al . Reductions in prescription opioid diversion following recent legislative interventions in Florida. Pharmacoepidemiol Drug Saf. 2014;23:314-20. [PMID:24677496 ] CrossrefMedlineGoogle Scholar - 12.
Reifler LM ,Droz D ,Bailey JE ,et al . Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Med. 2012;13:434-42. [PMID:22299725 ] doi:10.1111/j.1526-4637.2012.01327.x CrossrefMedlineGoogle Scholar - 13.
Islam MM ,McRae IS . An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions [Editorial]. BMC Pharmacol Toxicol. 2014;15:46. [PMID:25127880 ] doi:10.1186/2050-6511-15-46 CrossrefMedlineGoogle Scholar - 14.
Finley EP ,Garcia A ,Rosen K ,McGeary D ,Pugh MJ ,Potter JS . Evaluating the impact of prescription drug monitoring program implementation: a scoping review. BMC Health Serv Res. 2017;17:420. [PMID:28633638 ] doi:10.1186/s12913-017-2354-5 CrossrefMedlineGoogle Scholar - 15.
Moher D ,Liberati A ,Tetzlaff J ,Altman DG ;PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264-9. [PMID:19622511 ]. doi:10.7326/0003-4819-151-4-200908180-00135 LinkGoogle Scholar - 16.
Kaucher S ,Leier V ,Deckert A ,et al . Time trends of cause-specific mortality among resettlers in Germany, 1990 through 2009. Eur J Epidemiol. 2017;32:289-98. [PMID:28314982 ] doi:10.1007/s10654-017-0240-4 CrossrefMedlineGoogle Scholar - 17.
Sterne JA ,Hernán MA ,Reeves BC ,et al . ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. [PMID:27733354 ] doi:10.1136/bmj.i4919 CrossrefMedlineGoogle Scholar - 18.
Berkman ND ,Lohr KN ,Ansari M ,et al . Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville: Agency for Healthcare Research and Quality; 2008. Google Scholar - 19.
Kim M . The Impact of Prescription Drug Monitoring Programs on Opioid-Related Poisoning Deaths. Baltimore: Johns Hopkins Univ Pr; 2013. Google Scholar - 20.
Birk EG . Prescription Drug Monitoring Programs and the Abuse of Prescription Drugs. Eugene, OR: Univ Oregon; 2017. Google Scholar - 21.
Radakrishnan S . Essays in the Economics of Risky Health Behaviors. Ithaca, NY: Cornell University; 2015. Google Scholar - 22.
Meinhofer A . Prescription drug monitoring programs: the role of asymmetric information on drug availability and abuse. Am J Health Econ. 2017. [Forthcoming]. Google Scholar - 23.
Brown R ,Riley MR ,Ulrich L ,et al . Impact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity. Drug Alcohol Depend. 2017;178:348-54. [PMID:28692945 ] doi:10.1016/j.drugalcdep.2017.05.023 CrossrefMedlineGoogle Scholar - 24.
Phillips E ,Gazmararian J . Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality. J Opioid Manag. 2017;13:229-39. [PMID:28953315 ] doi:10.5055/jom.2017.0391 CrossrefMedlineGoogle Scholar - 25.
Dowell D ,Zhang K ,Noonan RK ,Hockenberry JM . Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates. Health Aff (Millwood). 2016;35:1876-83. [PMID:27702962 ] CrossrefMedlineGoogle Scholar - 26.
Pardo B . Do more robust prescription drug monitoring programs reduce prescription opioid overdose? Addiction. 2017;112:1773-83. [PMID:28009931 ] doi:10.1111/add.13741 CrossrefMedlineGoogle Scholar - 27.
Patrick SW ,Fry CE ,Jones TF ,Buntin MB . Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Aff (Millwood). 2016;35:1324-32. [PMID:27335101 ] doi:10.1377/hlthaff.2015.1496 CrossrefMedlineGoogle Scholar - 28.
Pauly NJ ,Slavova S ,Delcher C ,Freeman PR ,Talbert J . Features of prescription drug monitoring programs associated with reduced rates of prescription opioid-related poisonings. Drug Alcohol Depend. 2018;184:26-32. [PMID:29402676 ] doi:10.1016/j.drugalcdep.2017.12.002 CrossrefMedlineGoogle Scholar - 29.
Delcher C ,Wagenaar AC ,Goldberger BA ,Cook RL ,Maldonado-Molina MM . Abrupt decline in oxycodone-caused mortality after implementation of Florida's Prescription Drug Monitoring Program. Drug Alcohol Depend. 2015;150:63-8. [PMID:25746236 ] doi:10.1016/j.drugalcdep.2015.02.010 CrossrefMedlineGoogle Scholar - 30.
Bachhuber MA ,Maughan BC ,Mitra N ,Feingold J ,Starrels JL . Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: early evidence from 11 United States metropolitan areas. Int J Drug Policy. 2016;28:120-3. [PMID:26345658 ] doi:10.1016/j.drugpo.2015.08.005 CrossrefMedlineGoogle Scholar - 31.
Maughan BC ,Bachhuber MA ,Mitra N ,Starrels JL . Prescription monitoring programs and emergency department visits involving opioids, 2004-2011. Drug Alcohol Depend. 2015;156:282-8. [PMID:26454836 ] doi:10.1016/j.drugalcdep.2015.09.024 CrossrefMedlineGoogle Scholar - 32.
Kilby AA . Opioids for the Masses: Welfare Tradeoffs in the Regulation of Narcotic Pain Medications. Cambridge, MA: Massachusetts Institute of Technology; 2015. Google Scholar - 33.
Nam YH ,Shea DG ,Shi Y ,Moran JR . State prescription drug monitoring programs and fatal drug overdoses. Am J Manag Care. 2017;23:297-303. [PMID:28738683 ] MedlineGoogle Scholar - 34.
Paulozzi LJ ,Kilbourne EM ,Desai HA . Prescription drug monitoring programs and death rates from drug overdose. Pain Med. 2011;12:747-54. [PMID:21332934 ] doi:10.1111/j.1526-4637.2011.01062.x CrossrefMedlineGoogle Scholar - 35.
Li G ,Brady JE ,Lang BH ,Giglio J ,Wunsch H ,DiMaggio C . Prescription drug monitoring and drug overdose mortality. Inj Epidemiol. 2014;1:1-8. CrossrefMedlineGoogle Scholar - 36.
Delcher C ,Wang Y ,Wagenaar AC ,Goldberger BA ,Cook RL ,Maldonado-Molina MM . Prescription and illicit opioid deaths and the prescription drug monitoring program in Florida [Letter]. Am J Public Health. 2016;106:e10-1. [PMID:27153025 ] doi:10.2105/AJPH.2016.303104 CrossrefMedlineGoogle Scholar - 37. National Alliance for Model State Drug Laws. Components of a strong prescription monotoring/status program. 2004. Accessed at www.namsdl.org/library/2B94937F-1372-636C-DD57FE97A1B0345C on 2 January 2018. Google Scholar
- 38.
Mars SG ,Bourgois P ,Karandinos G ,Montero F ,Ciccarone D . “Every 'never' I ever said came true”: transitions from opioid pills to heroin injecting. Int J Drug Policy. 2014;25:257-66. [PMID:24238956 ] doi:10.1016/j.drugpo.2013.10.004 CrossrefMedlineGoogle Scholar - 39.
Worley J . Prescription drug monitoring programs, a response to doctor shopping: purpose, effectiveness, and directions for future research. Issues Ment Health Nurs. 2012;33:319-28. [PMID:22545639 ] doi:10.3109/01612840.2011.654046 CrossrefMedlineGoogle Scholar - 40.
Clark JD . Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage. 2002;23:131-7. [PMID:11844633 ] CrossrefMedlineGoogle Scholar - 41.
Joynt M ,Train MK ,Robbins BW ,Halterman JS ,Caiola E ,Fortuna RJ . The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. J Gen Intern Med. 2013;28:1604-10. [PMID:23797920 ] CrossrefMedlineGoogle Scholar - 42.
King NB ,Fraser V ,Boikos C ,Richardson R ,Harper S . Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review. Am J Public Health. 2014;104:e32-42. [PMID:24922138 ] doi:10.2105/AJPH.2014.301966 CrossrefMedlineGoogle Scholar
Author, Article and Disclosure Information
Columbia University, New York, New York (D.S.F., J.P.S., A.S., K.K.G., S.S.M.)
University of Florida, Gainesville, Florida (C.D.)
University of California, Davis, Sacramento, California (A.C., A.E.R., S.G.H., M.C.)
New York University, New York, New York (J.H.K.)
Note: Mr. Fink had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Disclaimer: Viewpoints or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice.
Grant Support: By grant R01 DA039962 from the NIDA, National Institutes of Health (NIH), and grants 2016-PM-BX-K005 and 2015-PM-BX-K001 from the BJA. Mr. Fink is supported by NIDA training grant T32DA031099. The BJA is a component of the Department of Justice's Office of Justice Programs, which include the Bureau of Justice Statistics, National Institute of Justice, Office of Juvenile Justice and Delinquency Prevention, Office for Victims of Crime, and Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking.
Disclosures: Mr. Fink and Dr. Kim report grants from the NIH during the conduct of the study. Ms. Grover is employed as a research coordinator at Duke University for an NIDA Clinical Trials Network study outside the submitted work. Dr. Delcher reports grants from the BJA (National Institute of Justice) during the conduct of the study. Dr. Martins reports grants from the NIDA during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3074.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See Supplement 1. Statistical code and data set: Not available.
Corresponding Author: David S. Fink, MPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 724, New York, NY 10032; e-mail, [email protected]
Current Author Addresses: Mr. Fink, Ms. Schleimer, Mr. Sarvet, Ms. Grover, and Dr. Martins: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 724, New York, NY 10032.
Dr. Delcher: Department of Health Outcomes and Biomedical Informatics & Institute of Child Health Policy, College of Medicine, University of Florida, Gainesville, FL 32610.
Dr. Castillo-Carniglia, Ms. Rivera-Aguirre, and Dr. Cerdá: Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817.
Dr. Kim: Behavioral Science Training in Drug Abuse Research, New York University (Rory Meyers College of Nursing), New York, NY 10010.
Dr. Henry: Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817.
Author Contributions: Conception and design: D.S. Fink, S.S. Martins, M. Cerdá.
Analysis and interpretation of the data: D.S. Fink, J.P. Schleimer, C. Delcher, A. Castillo-Carniglia, S.G. Henry.
Drafting of the article: D.S. Fink, J.P. Schleimer, A. Sarvet, C. Delcher.
Critical revision for important intellectual content: D.S. Fink, J.P. Schleimer, A. Sarvet, C. Delcher, A. Castillo-Carniglia, J.H. Kim, A.E. Rivera-Aguirre, S.G. Henry, S.S. Martins, M. Cerdá.
Final approval of the article: D.S. Fink, J.P. Schleimer, A. Sarvet, K.K. Grover, C. Delcher, A. Castillo-Carniglia, J.H. Kim, A.E. Rivera-Aguirre, S.G. Henry, S.S. Martins, M. Cerdá.
Provision of study materials or patients: D.S. Fink.
Statistical expertise: D.S. Fink, J.P. Schleimer.
Obtaining of funding: S.S. Martins, M. Cerdá.
Administrative, technical, or logistic support: D.S. Fink.
Collection and assembly of data: D.S. Fink, J.P. Schleimer, K.K. Grover.
This article was published at Annals.org on 8 May 2018.
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
*All comments submitted after October 1, 2021 and selected for publication will be published online only.